'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Vaccination prevents four in five flu deaths

Pneumococcal vaccination in the elderly does not protect against pneumonia and provides only 50 per cent protection against invasive pneumococcal disease, according to a new systematic review.

Researchers said the 23-

valent vaccine used in the elderly had been controversial since its introduction, because of the lack of robust evidence for its effectiveness.

The study, published in Vaccine (August), analysed data from 13 observational studies, giving estimates of between 46 and 59 per cent for the vaccine's effectiveness against invasive pneumococcal disease.

But only five studies gave adequate data on all-cause pneumonia, with estimates of effectiveness varying widely. While one study suggested the vaccine gave 50 per cent protection, the most recent, lar-gest and best-conducted study found no benefit.

Lead author Dr Stephen Conaty, a consultant in public health at Islington PCT, said the vaccine had been introduced on sparse evidence, but that future conjugate vaccines should be an improvement.

The Health Protection Agency said a recent study had found the routine vaccination of all elderly patients was cost-effective.